Vaginal Erotic Sensitivity By Sexological Examination: A Journal Article I Read

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If you remember, I recently reviewed a journal article I reluctantly paid $40 for. Well, there was one more that I paid that stupid money for, and I'm going to review it now (I will share this one too - just write me at trisha att ancmovie dott com). It's another article that is often brought out when trying to prove something about the validity of vaginal orgasms because is says in the abstract that 64% of the women who couldn't vaginally orgasm before were shown how to stimulate the vagina correctly and then could vaginally orgasm through either coital or direct digital stimulation of the vagina. Sounds pretty promising, yes, but as is the norm with vaginal orgasm studies, it actually still doesn't record or observe any actual orgasms. I'll certainly give it to this study for being a sensible enough study. This one was published in 1986, not 2 years after the hot mess of a study I just wrote about, but it takes much more care with the scientific method, even though it mentions that hot mess study as a possible control for this study...but we'll get to that later. Here, for your enjoyment, is:

Vaginal Erotic Sensitivity By Sexological Examination
Acta Obstet Gynecol Scand 1986;65(7):767-73
Hoch, Z.

Abstract

We studied vaginal erotic sensitivity by vaginal sexological examinations as part of the evaluation and treatment process of couples complaining of female coital anorgasmia but readily orgasmic at female self--or partner-performed external genital stimulation. The existence on the anterior vaginal wall of an anatomically clearly definable erotically triggering entity, termed "The G Spot", was refuted by our findings. The entire anterior vaginal wall, including the deeper situated urinary bladder, periurethral tissues and Halban's fascia, rather than one specific spot, were found to be erotically sensitive in most of the women examined, and 64% of them learned how to reach orgasm by direct specific digital and/or coital stimulation of this area. All other parts of the vagina had poor erotic sensitivity. This supports our conceptualization of a 'clitoral/vaginal sensory arm of orgasmic reflex' including the clitoris, the entire anterior vaginal wall as well as the deeper situated tissues. Instead of looking for a 'vaginal (coital) orgasm' distinctly different from a 'clitoral orgasm', this concept speaks towards a 'genital orgasm' potentially achievable by separate or, most effectively, combined stimulation of those different trigger components of the genital sensory arm of the orgasmic reflex. The format and technique of the vaginal sexological examination are described, and its possible applications and limitations are discussed.

Background

• Okay, so there is this Center for Sexual Therapy in Israel where couples were referred for sexual problems. The study was conducted on 56 of the 59 (3 couples declined to take part in the full study) hetero, married couples who came into the clinic over a period of 1 year. These couples were ones in which women could orgasm through outer genital stimulation, but not through intercourse alone. 
• This group was 49% of the total number of women in that clinic over that year who complained of sexual dysfunction. 
• The women in this group ranged in age from 19 to 64 years and the men from 21 to 64. Their average age difference in the couple was 2.8 years and their average age at marriage was 22.4. 
• They were also described as "with a generally good relationship between the partners," and I would guess they have good data for that because the couples (along with all other couples that came into the clinic) were put through a battery of tests including, the Israeli Minnesota Multiphasic Psychological Inventory, the Bem Sex Role Inventory, the Sim-Fam (a game application of decision -making within the family), anthropomorphic measures of sexual dimorphism, a detailed sociological questionnaire, and the Leif and Ebert Sexual Performance Evaluation Questionnaire. 
• They also, "underwent a detailed clinical and sexological interview and physical examination, all performed by the present researcher - a gynocologist also trained in sex therapy- who classified them according to Safir-Hoch Couple Interactional Classification of Sexual Dysfunction." Present researcher meaning Zwi Hoch, the sole author of this study and apparent creator of the sexual dysfunction classification system above.
• "All interviews, physical examinations and classifications were done independently from, and ignoring, the data content previously gathered by the battery of tests."
• These 56 couples who complained of female coital anorgasmia (cannot come from intercourse alone, but can come with external genital stimulation) also took part in vaginal sexological exam. The purpose and techniques were discussed with and agreed upon by the couple.  "It was understood that, in addition to the insight and learning experienced by the couple, as a result of the vaginal sexological examination, the conclusions reached would also be included anonymously in a continuing prospective research study on female genital sensitivity." 
• Following their vaginal sexological examinations, the couples were each interviewed at least 3 more time, in 10 day intervals, to follow up on their at-home experiences with vaginal erotic response brought on by direct stimulation performed by the partner. Experience with outer genital sensitivity was not researched for this study.

The Vaginal Sexological Exam

• The partner is present for the whole thing
• The female is in your basic gynocological position, the the feet up in stirrups but sitting up a bit instead of layed all the way back, and with the shirt no pants situation. (oh and she peed before the exam to empty the 'ol bladder)
• 5 women had severe vaginismus (the vagina tenses up during or in anticipation of certain kinds of penetration and causes pain) and it says that the doctor did not "first proceed with the gynecological examination," with these women, but it give no more details about this. I don't know if they were excluded from the study or simply changed procedure for them.
• The couple is informed of any organic pathology down there. 
• The author points out that, "Inspection and palpation of the external genitalia may reveal involuntary contraction of the pubococcygeal (PC) muscles, in which case it is advisable to ask the patient to contract and relax the anal sphincter, thhus teaching her how to control at will her perivaginal musculature."
• The woman introduces first her own finger and then the examiners finger into he vagina, with proper lubrication of course. 
• The examiners fingers are then gently moved around and the woman is asked to indicate the sensory feelings during stimulation of different parts of the vagina. "Her reactions are recorded. If she indicates discomfort, pain, or no special sensation, the fingers are slowly moved on, until an erotically reactive area is identified. Stimulation is then continued on this area for a while, but never longer than required for reaching the excitement phase or beginning plateau phase of her sexual cycle. 
• When stimulating the anterior wall, pressure applied with the second hand on the suprapubic (the low, low belly - like at the upper pube-hair area) region proved to be very helpful in enhancing the patient's sensation. This bimanual stimulation is performed in a steady circular fashion, almost bringing the two examining hands together. 
• The doctor's external hand is then replaced by the patient's hand, teaching her how to locate, through her abdominal wall, the intravaginal examining fingers. 
• The partner then takes the physician's place and, under the patient's instructions, proceeds with similar stimulation. 
• The stimulation, now performed by the sexual partner in the clinical setting, should preferably also not surpass the primary learning phase of a beginning-plateau level of sexual response. Instead, they are "advised to apply in the privacy of their own home the same form of vaginal stimulation which was found to evoke erotic sensations, this time obviously continuing it until the woman reaches, if possible, orgasmic release."
• The insights learned from the vaginal exam are carefully discussed with the couple, emphasizing the woman's particular areas of erotic sensitivity and the correct technique required for "successful vaginal stimulation." "Repeated technical instruction is sometimes needed at their next visit to the office.

Results

• As in the last study I described, most of the women found the anterior (towards belly) wall of the vagina to be erotically sensitive (85% - highly erotic, 11% slightly erotic). Most women found the posterior (towards butt) and the lateral vaginal locations (at 4 o'clock and 8 o'clock) to have no erotic sensitivity (97% and 98% respectively). And stimulation of the cervix area was either not erotic (27%) or uncomfortable (67%). The table is below.

• "In a constantly repetitive manner, 96% of the women examined indicated almost immediate erotic sensitivity during stimulation of the entire anterior vaginal wall, generally accompanied by some sort of involuntary rhythmic circular pelvic movements and/or slight tremor of both thighs. This sensation was generally described to be quite similar in quality, although lower in intensity, that clitorally evoked erotic sensitivity already familiar to them. Most of them have been previously unaware about the potential existence of erotic sensitivity int he anterior vaginal wall region."
• "At subsequent follow-up visits, up to one month postexamination, 64% of the couples reported achieving orgasm by specific continuous anterior vaginal wall stimulation performed digitally or by anteriorly directed intercourse."
• However, most of the women reported that combined clitoral and vaginal wall stimulation was the best - even better than stimulating either are by itself.
• Of the 36% of women who did not later report achieving orgasm through vaginal stimulation, "the majority stressed the fact that this form of stimulation, as to now, became an important addition to their sexual excitement techniques towards the achievement of orgasm by simultaneous clitoral and vaginal stimulation."

Discussion
In the discussion, the author points to how the "sporadic" clinical studies regarding subjective erotic sensitivity of the vagina compares his own findings.

1. One study saying the muscle laying behind the 4 o'clock and 8 o'clock positions "contains sensory and motor elements of the female orgasm and that the use and training of this muscle is significant in helping clitorally orgasmic women become orgasmic by penile/vaginal stimulation." Obviously, this study identified little to no sensitivity in that area.
2. Also, Singer&Singer, Tordjman, and Kikku all say that the cervix and posterior fornix (depth of the vagina) are erotically important, but this study disagrees - since that area was generally either not erotically sensitive or even painful to women in this study.
3. Kinsey observed erotic sensitivity on the anterior wall of the vagina, but "concluded that this was of minor importance and that the clitoris was the prominent female sexual organ, being her homologue to the male penis." The author thinks his conclusion differs from Kinsey's because Kinsey used metal, cotton-tipped, and plastic probes to test for sensitivity, and this author used lubed, gloved fingers stimulating in various ways according to patient instruction.
4. Grafenberg and Whipple, Ladas and Perry, who named the G-spot (after Grafenberg actually) and introduced it to the masses not a couple years before this study was released, say there is a distinct spot on the anterior wall that raises and can be specifically felt after she is aroused, and that this spot is the "most important site of vaginal erotic sensitivity." However, the author found no "spot" like this, only sensitivity on the entire anterior wall.

In light of this study, the author would like to "include the anterior vaginal wall and the more deeply situated tissue, together with the clitoris and introitus vaginae (outer vag-hole area), as separate but potentially integral components of the sensory arm of the female genital orgasmic reflex." In other words, he believes that his study could prove that vaginal stimulation could be another method for making women come besides outer vulva/clitoral stimulation.

The author then goes on to say that the proposed idea above brings to light what he believes is "an important aspect of female sexuality." Probably, he tells us, many of the women who could orgasm, but couldn't orgasm through vaginal stimulation lack the "awareness and understanding of the importance of anterior vaginal wall stimulation." Normal intercourse doesn't do much for anterior wall stimulation, and without it, he tells us, intercourse orgasms may not be achieved. However, he proposes that, "after adequate evaluation, including the vaginal sexological exam, a substantial group of patients can be identified in whom the teaching of the importance of anterior wall vaginal wall stimulation before and during intercourse, by manual and anterior wall directed penile intromission, will help help them reach orgasm during coitus." In fact he thinks that it is "reasonable to expect" that as time goes on and they gain more experience, more than the 64% of couples in this study will be able to reach orgasm this way. "It should be emphasized, however, that even then, simultaneous anterior vaginal wall and clitoral stimulation has the potential for best results."

Also, this author does not feel "that failure to reach a climax during intercourse should be regarded in all cases as normal variation of female sexuality." - cause, you know, them ladies can be taught the right way to stimulate that vag into an orgasm.

The Control Group Situation
It is also mentioned in the discussion that there was no control group used. A control group could have been, the author writes, a group of women who were just told how to stimulate the anterior vaginal wall or a group that only received a normal pelvic exam. The author could then have checked back in with these ladies up to a month later to see if they were able to achieve vaginal orgasms and compared to the women who did receive the vaginal sexoogical examination. However, the author doesn't see these as very useful control groups.

He then says that, "under the circumstances, Alzates' work on paid and unpaid volunteers undergoing a researcher performed vaginal sexological exam very similar to our own, provided, we felt, the best albeit partial and temporary, solution to our 'control group dilemma..." That's right, the hot mess of a study I last overviewed is pointed to as a control group. It's not completely clear to me why this would be an okay control group, but I think it is because those women were just a group of women (so maybe a control in that way), and this study is all women who specifically have never orgasmsed vaginally and came to a clinic to help remedy that situation.

Conclusion

• The author believes women who are orgasmic ONLY through stimulation of the external genitals should not be considered sexually dysfunctional, but as functional, but "often misinformed, and therefore unaware, with regard to their sexual anatomy and physiology. The new form of vaginal sexological examination described in this paper has proved to be, in our experience, an educational tool in helping such individuals."
• They reject the idea put forth by previous researchers about the orgasmic merits of the 4 o'clock and 8 o'clock areas of the vagina. 
• They also think 'The G Spot' label "should be avoided by professionals and lay people alike in order to prevent the unfortunate appearance and perpetuation of a new sexual myth." This, they say, because they found the entire anterior vaginal wall to be sensitive and believe it can be stimulated to orgasm. However, they did not find a particular spot that is sensitive and can be stimulated to orgasm, as Whipple, et al did in their G-spot-introducing book not 2 years earlier.  I'd like to quickly point out that this disagreement about a spot vs. a large area being the place where vaginal orgasm is stimulated from is still a huge issue today. In fact the word G-Spot since then has come to mean both those things depending on who you are talking to, yet people are rarely specific about which they mean. So, like the word, 'orgasm,' 'G-Spot' now tends to mean whatever the person saying it wants it to mean, and it's confusing as hell. So, maybe this author was on to something about not using the word anymore. (p.s. I always use the word to mean the raised area felt through the vaginal wall where the tissue surrounding the urethra and containing the female prostate exist - if stimulating it leads to any kind of sexual release, it would be an ejaculation - given that this is the only observed and recorded scenario - never yet an orgasm.)
• Oh - and again there is an emphasis that a combo of vaginal and clitoral stimulation is most effective.
•  "There is no such thing as a 'vaginal orgasm' distinctly different from a 'clitoral orgasm', but rather a genitally evokable sexual orgasm brought about by separate or combined stimulation of the different trigger components of the genital sensory arm of the orgasmic reflex." So, in this, they are saying that a vaginally evoked orgasm is no different than the universally agreed-upon definition of the clitorally evoked orgasm that Masters and Johnson identified and described...with the rhythmic muscle contractions and all that. Thus, from my understanding, the orgasms attained from stimulation of the anterior vaginal wall, should include those rhythmic muscle contractions. This study does not check for that given that the orgasms happened in the privacy of the patient's home. However the Alzate study, identified here as a possible control study; specifically said there didn't seem to be those rhythmic muscle contractions during the time women claimed to have orgasms from anterior vaginal wall stimulation, and actually suggested that the vaginally stimulated 'orgasm' might be something different. So my point is, this study didn't observe any actual orgasms, and a similar study, identified here as a control to this study, that included the researchers hand in the woman's vagina at the time she claimed to orgasm (not a great standardized measuring tool, but something none the less) said that no contractions were felt and that the vaginally induces orgasm is not the same as a clitorally induced orgasm. So, there is a discrepancy here, and I would think, since the other study is indicated as a control group, this discrepancy should have been discussed, but it was not.

Special Comments
The author wanted to note the sensitive nature of this vaginal sexological exam. It should be done with consent, in a normal medical area, with a female nurse or partner present - all that fairly basic stuff. He goes on to say, "special care should be taken to limit the vaginal stimulation to the shortest time span necessary for arriving at a diagnosis, thus avoiding high levels of sexual excitement, which could evoke guilt feelings in the patient and unnecessary fears in the partner of having to 'compete' with the more knowledgeable (and often male) physician." So, he believes only physicians trained in management of sexual problems should do this therapy.

My Final Thoughts
So there you go. I have a couple things to get out real quick.
1. This study is so typical of vaginal-stimulation-causes-orgasm studies. It shows clear observations that vaginal stimulation can be pleasurable and arousing, but then simply doesn't get clear observations that an orgasm can also occur from vaginal stimulation. Generally the researches simply ask the woman while in a clinical setting to say when she orgasms, but do not use any way of recording the physical things happening in her body while she says this (that study discussed here as a possible control is one of the very, very few exceptions to this), or as in this study, they simply ask the woman if it happened sometime while not in the clinical setting. I get the reasons why this author did not attempt to take women to orgasm, but I think it would have been a better study if he had tried. As it is now, this study did not give us any new information about what a vaginally induced orgasm might be.

I also want to take a minute to point out some problems with simply asking these women if they came. 64% said, in the presence of their male partner and the authority figure who showed them how to achieve vaginal orgasm, that they did in fact come this way. One possibility is that these 64%  of women did orgasm, and that is the assumption this study takes without question.

However, there is another, not so wild, possibility; anywhere from some to all of those 64% of women didn't orgasm, but said they did. Think about it. A woman can orgasm, but not the way that makes her a full mature women (it's 1986 - Freud is still looming large), not in a way that is easy or convenient for her husband, not in a way that makes her husband feel like a stud of a man, not in a way that seems 'normal'. It is such a problem, that this couple comes to get therapy for it. The doctor they meet, indicates, maybe not with words, but from the sexological exam that he does and the homework he gives them (to continue the stimulation till orgasm occurs) assumes that is it certainly possible for the woman to orgasm vaginally if she and her partner work at it hard enough. The whole situation points to the problem being her and her alone, if it still doesn't work when she gets home.  So, what I'm saying here is that this particular situation puts a lot of pressure on the woman to achieve the goal she came to that clinic to achieve. A professional has shown her how to do it, and her partner is probably trying his darndest to get it done. It would be a shame if she still couldn't do it, now wouldn't it?

I am not saying this is definitely what is happening, but it is not so far fetched. It is a possibility that should have been considered in both the methodology creation and the conclusion, but it is not considered at all, and that, my friends is concerning.